Healthcare Provider Details

I. General information

NPI: 1114118163
Provider Name (Legal Business Name): MATTHEW J ELIAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-4327
US

IV. Provider business mailing address

3100 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-4327
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-0582
  • Fax:
Mailing address:
  • Phone: 954-771-0582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS9756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: